GAO: Consumers Face Difficulties in Getting Prices Upfront

The lack of health care price transparency presents a serious challenge for consumers who are increasingly being asked to pay a greater share of their health care costs, says a new report by the Government Accountability Office (GAO) that examines the difficulties consumers face in obtaining price information, particularly estimates of what their complete costs will be prior to receiving care.

For this report, GAO studied various factors affect the availability of health care price information for consumers. It also looked at the information made available to consumers from selected public and private health care price transparency initiatives. GAO examined a total of 8 selected federal, state, and private insurance company health care price transparency initiatives; reviewed price transparency literature; and interviewed experts. In addition, it anonymously contacted providers and requested the price of selected services to gain a consumer's perspective.

GAO's investigation found several health care and legal factors that can make it difficult for consumers to obtain price information. The health care factors include the complexity of predicting health care services in advance, billing from multiple providers, and the variety of insurance benefit packages. In addition, GAO identified several legal factors that may prevent the disclosure of negotiated rates between insurers and providers, which may be used to estimate consumers' complete costs.

Of the 8 public and private price transparency initiatives GAO examined, 2 initiatives—1 publicly available with information only for a particular state and 1 available to members of a health insurance plan—are able to provide an estimate of a consumer's complete cost in part because of they have access to claims data and negotiated rates. The remaining initiatives either do not use more meaningful price data or are constrained by other factors, including concerns about disclosing what providers may consider proprietary information, says the report.

In its recommendations, GAO calls for the Department of Health and Human Services to determine the feasibility of making estimates of complete costs of health care services available to consumers.